Bed Sharing as Safely as Possible: It’s About Risk Reduction

Bed Sharing or Co-Sleeping?

The first thing to get out of the way is the difference between co-sleeping and bed sharing. They aren’t the same, though they are often used interchangeably. Co-sleeping is sleeping in the same vicinity as your infant, or what experts call ‘within sensory range’. This means you can hear, see and (yup) smell baby. Bed sharing is a type of co-sleeping. Bed sharing means you are sharing the same sleep space, namely a bed, with your baby. This is a small, but significant difference.

I get asked all the time “Can I bed share safely?”. The answer is ‘Yes, BUT,” with a capital “B-U-T.” Bed sharing comes with risks. The debate over safe bed sharing continues to rage in the clinical and public health community. Parents can make the best choices when they are fully informed. Here we go.

A History of Bed Sharing

1990s

In the mid 90’s, the American Academy of Pediatrics (AAP) came out with a strong statement against babies sleeping on their bellies. However, their stance on bed sharing was less than strong, stating:

“Bed sharing or co-sleeping may be hazardous under certain conditions”

Just “may,” huh? And what were those “certain conditions” they speak of? That’s for another history lesson, kids.

2005

What we do know is that by 2005, the AAP swung definitively into the camp of “no bed sharing.” The taskforce cited several studies which demonstrated increased risk of death with bed sharing. Now, I’m not going to go into detail on the complexities of the world of infant sleep death, how those deaths are coded medically or how the data is collected. That, too, is for another time.

What I can tell you is the AAP drew a firm line in the sand with anti-bed sharers on one side and sleep-cuddler, pro-bed sharers on the other. And it hasn’t been pretty. Ever since then, safe sleep advocates have taken an “abstinence only” or risk-elimination stand when it comes to bed sharing. I used to be one of them. I would have new moms ask me in a quavering voice how they could bed share safety, and I would reply, “NEVER!!!” I’m sorry mamas. I didn’t know any better then. I’ve grown a lot since my wee first days in injury prevention. I’ve learned that a risk-reduction technique is way better for families, and it actually meets them where they are, which is usually somewhere between desperate and exhausted.

2016

However, in October 2016, the AAP eversoslightly softened their stance on bed sharing. To be clear, the AAP still does not endorse bed sharing and they still believe the safest place for baby to sleep is in their own sleep space (which is actually true). However, the AAP finally acknowledged that many parents (like 60% of parents in fact) are sometimes falling asleep with their baby. And this is despite being educated on safe sleep. What that means is that parents are EXHUASTED. And we need to throw them a damn bone.

Safe Sleep Recommendations

A member of the AAP Safe Sleep Taskforce, Dr. Lori Feldman-Winter says
“If you are feeding your baby and think that there’s even the slightest possibility that you may fall asleep, feed your baby on your bed, rather than a sofa or cushioned chair. As soon as you wake up, be sure to move the baby to his or her own bed,” she said. “There should be no pillows, sheets, blankets or other items that could obstruct the infant’s breathing or cause overheating.” Great!

Which brings us to the recommendations.

Place baby on their back to sleep. Every.Single.Time. No grandma, it’s not 1892 anymore and we don’t put babies on their bellies or even their sides.

Use a firm sleep surface. This is one that doesn’t indent or conform to baby’s shape. No bean bags, no memory foam, no nothin’ that is too soft.

So You Wanna Bed Share…

Ok, you’ve read all the recommendations and you feel like you might be interested in bed sharing. How to do it so that you are reducing as many risks as possible?

Baby on Back

1) First and foremost- place baby on their back to sleep. Every time. If you are swaddling, stop by the time baby reaches 2 months or earlier if baby is showing signs of rolling over.

Mattress Only

2) No couch, recliner, over-stuffed chair, hammock, chaise lounge sleeping. Ever. Or anything other than a mattress. But you were getting that hint, right?

Make that FIRM Mattress Only

3) Check out your mattress. Is it super soft? Is it going to indent when you lay baby on it? If so, your mattress and baby may be headed for a break up.

Check Mattress Location

4) Where is your bed located? If your bed is near a wall or piece of furniture, see if you can pull it away from anything that could pin baby if s/he ever rolls off the bed. Babies have died when they crawled or rolled to the edge of the bed and became trapped between the mattress and wall (or piece of furniture). Consider putting your mattress on the floor.

Clear Everything but You and the Baby

5) What do you have on your bed? Is your bed filled with tons of pillow, blankets, dogs, a partner, other kids, etc.? It all needs to go. Baby needs to have a sleep space clear of anything that could obstruct their tiny nose and mouth. That includes soft stuff as well as other humans and pets. I hear Target is having a sale on adult footed pajamas.

No Smoking

6) Are you smoking? Baby goes in a crib or Smitten. Smoking is a big risk factor for SIDS.

No Drugs (legal or illegal) or Alcohol

Smitten can be placed right next to your bed for those nights when you’ve had a glass (or three) of wine.

7) Did you drink tonight or take meds that might make you drowsy? That means baby sleeps separately from you. Remember, baby can be right next to you in a bassinet (like the Smitten). But when you are not able to fully rouse, it’s dangerous to sleep with baby.

Check the Temperature

8) Chances are, it’s not the North Pole in your house. Put baby in one more layer than what you are comfortable in.

Check your Baby’s Age

9) Babies 0-4 months of age are at increased risk of SIDS. Be particularly vigilant if your baby is less than 4 months old.

Use a Pacifier

10) If breastfeeding is well established, offer a pacifier.

Of course, these steps can’t 100% prevent SIDS. But you can certainly reduce the risk by following these guidelines. Happy parenting!